Individual
LACRESHA PAUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
216 E APACHE ST, FARMINGTON, NM 87401-6904
(505) 427-4839
(505) 258-4356
Mailing address
216 E APACHE ST, FARMINGTON, NM 87401-6904
(505) 427-4839
(505) 258-4356
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
NM
3747P1801X
Personal Care Attendant
—
NM
376J00000X
Homemaker
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
88-2736466
—
NM
Enumeration date
07/05/2022
Last updated
07/05/2022
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